POTS (postural orthostatic tachycardia syndrome).

I see the Daily Mail ran a story recently saying that POTS could be the 'cause' for 1 in 3 people with CFS. Having heard the woman who heads the research team at Newcastle university talk a couple of years ago I remember thinking at the time she is never going to work out the neurology of this because she's too narrow in her focus. She spent the first 20 mins of the talk (to University Researchers) justifying that CFS is a real disease and not just malingering (presumably the medics that she normally lectures to have that belief). Then when she got to the heart of her presentation and described how they put people on a 'tilt' table to measure their responses (this apparently is how they diagnose it). sounded barbaric and very unpleasant! However, my main bone of contention and one that has been repeated by the Daily Mail is that this is somehow the 'cause' of CFS when clearly it is just another result of autonomic dysregulation (mediated by the limbic system). A client of mine has pointed me to a training programme called DNRS (Dynamic Neural Retraining System) which she uses - I noted they had an article on POTS too. http://www.dnrsystem.com/POTS.html. They say;

Symptoms can include but are not limited to:

• Increase in heart rate, dizziness, fainting, headache, sweating, shakiness, nausea -  mostly worse with standing
• Poor concentration and memory
• Discoloured hands and feet
• Sense of anxiety
• Chest pains
• Nerve pain
• Hyperacusis (sensitivity to noise)
• Photophobia (pain/relapse on exposure to light)
• Changes in taste and smell

I can remember having most of these symptoms when I was ill 15 years ago - however, no-one seemed to be able to link all of these symptoms - they were all treated separately. The first thing I was given was tablets for the dizziness which made no difference at all. However, had I been diagnosed with CFS or POTS for that matter it wouldn't have helped as it is still a descriptive diagnosis of exclusion (i.e we don't know what it is but it's not something neurological/structural, it's characterised by these things so we'll call it CFS/POTS, etc). So, given a diagnosis like that people are left to manage the symptoms with no idea that the limbic system controls all of these things and that ongoing subconscious stress is triggering the limbic system into sympathetic dominance or vagal freeze. Without understanding what is behind it all people are left powerless and controlled by a medical system that then feeds them expensive drugs and surgery as the answer. It would be quite criminal if it wasn't legal...

Polyvagal Theory and the origins of Chronic Fatigue

My recent reading has led me to discover a theory first identified by Stephen Porges on Polyvagal theory of development. This states that there are three levels of the autonomic nervous system which relate to which era of our evolutionary development they originated in.

1. The unmyelinated vagus nerve which developed 500 million years ago in the fish. Myelin is the covering or sheath around nerve fibres which makes them insulated and able to transfer nerve impulses very fast so without it the messages are necessarily slower. 
2. The sympathetic nervous system (or fight' and flight' system as many know it) which is based on basal ganglia from the spinal cord - this comes from our mammalian past.
3. The myelenated vagus belonging to the parasympathetic system which is the opposite to fight and flight in that it is responsible for calming us down and giving us time to relax and enjoy interaction with others (the social bonding system).

If this is down-regulated as it often is with chronic stress we will be forced into the level below (i.e. sympathetic dominance) where we are ready to 'fight the tiger', our heart rate will be high, and our gut unable to function as blood is diverted away from it - hence churning and IBS symptoms. If our systems are even more exhausted (as they are with years of chronic pain in for instance chronic fatigue syndrome) then the other two levels are hijacked and we operate in the 'freeze' mode of the unmyelinated vagal system (freeze state) whereby nothing works. Our energy levels are so low we cannot function, even the most moderate tasks exhaust us. Our mitochondria are getting the signal to 'go slow'.. It down-regulates all metabolic activity. We are operating at the level of a reptile.

The next question is why and this is where my researches and experience working with people suffering from chronic fatigue shows me that subconscious trauma (perhaps more accurately termed unresolved emotion) seems to be the key here. If, in early life, the person suffers a traumatic experience and interprets that they are worthless or dangerous, then any subsequent event which plays into this subconscious belief system will trigger the body to go into a meltdown freeze state. The earlier the traumatic event in the person's life the more likely this is. Women also seem to be more biologically prone to this as men are more likely to go into fight and flight.

There may be periods of remission where the person has a reasonable ability to function but the next event which triggers these subconscious beliefs they will go downhill again. Thus it explains both the metabolic fatigue and the relapse and remission cycle common to all fatigue syndromes (ME, CFS, Fibromyalgia). Remember these events are recorded in the emotional brain or limbic system with the sensations and emotions that they first caused. They are processed differently from normal memories and may get 'stuck' in the emotional brain/limbic system where they continue to dictate behaviour and  symptoms.

I want to present this theory to the chronic fatigue community - including other clinical professionals at a webinar specifically set up so that we can understand why tinkering at the top level i.e. with diet and pacing can seldom work, if it doesn't approach the real underlying causes of the subconscious neural processing. Thus in summary, we are emotional beings with three increasingly sophisticated nervous systems overlaid on top of eachother (note also this occurs in the brain as well - see the Triune brain theory) - the final one belonging to a reptilian past. If, due to life circumstances this one becomes dominant as the others are suppressed, then our life becomes severely and devastatingly limited. In the next blog I'll be talking about how we can reverse this suppression with various tools from energy psychology.

With thanks to the writing of Peter Levine for these insights and my clients for their practical application.

August musings on mindbody medicine and trauma

August the month of holidays... someone said on the radio today that August is the 'Sunday' of the months and I agree. It feels like a last-ditch effort to enjoy the sun and note how the nights are drawing in. And yet it's just part of the cycle of life really.

Interesting how in having 'down-time' the mind will remember other times you had that response. I had a client in recently who was about to go on holiday but was having very mixed feelings as she has lost her father recently and she was about to return to his former home in Italy. This manifested though as odd sensations and aches in her back and down her legs. Now, you will know if you have read anything I've written before that I am very much a believer in the mindbody connection. I told her it was very likely that these odd pains were linked to her imminent departure but that she should get checked at the doctors just in case. The doctor gave her a clean bill of health so we were left to work on the symptoms from a mindbody perspective.

According to my experience and the work of Dr. John Sarno, it seems that the mind will create aches and pains to distract you from the more painful and serious emotional pain that you are trying to avoid confronting. I know if you haven't come across this idea before it may sound strange but time and time again I have proved this. Anyhow, it seemed a classic case to me as these pains had come on suddenly a few days before her intended departure.. In our therapy session we started with EFT (emotional freedom technique or tapping) which allows you to both own the symptom but also release it. As we worked together I saw a wave of emotion appear to come from her stomach (where she had located the current pain) and wash over her face - tears soon followed. There was a tremendous amount of grief pent up in this person, which she hadn't really dealt with.

Leaving to go away was both pleasurable (it was a holiday after all) and painful as it was the place she had last seen her father AND in order to go she had to leave her elderly cat who was also very dear to her and who is on borrowed time already. This is a classic case of internal conflict; you both want to do something and you don't want to. The guilt and conflicted feelings come out with back-ache or sciatica or whatever. How can you tell if what you have is a true pathology (i.e structural problem) or a mind-body issue? Chase the pain. What I mean by this is use the EFT protocol (detailed and described in detail on my website www.alchemytherapies.co.uk/eft.htm) to apply the tapping protocol and see if the pain moves. it usually changes in some fundamental way pretty quickly.

For my client, I had instructed her to do this the night before she came to see me as it would give me a strong clue as to whether to treat the pain with physical or mindbody therapy. She reported that it went from her legs to her stomach. So, I had a pretty good idea we were dealing with a mindbody problem. In the therapy we did together the pain moved again from a tightness in the stomach to a constriction in the throat (interesting as this often reflects something unspoken). As we continued this developed into a full blown panic attack so I asked her to move to the table and we worked on calming the autonomic nervous system with belly breathing (which helps to break the shallow breathing- oxygen deprivation cycle triggering panic in the brain) and then I helped her speak her pain and then we shook her limbs to release the pent up emotion  (this last approach has been detailed in Peter Levine's work - Waking the Tiger and Healing Trauma). I find it helps people to experience their emotion through their body which is where it resides. There is much theory around how the mind and subconscious process interact. Again, see the information on my website.

Suffice to say I was successful in this treatment and my client left -shaken obviously but no longer having the trauma in her body. Her pain disappeared immediately and she has recently sent me a text from holiday saying how much she is enjoying herself. (though it's worth noting for accuracy that she did experience another panic attack at a subsequent time - one session is not going to undo 40/50 years of trauma!).

If any of this sounds interesting or you have anything to add please contact me through my website or facebook pages.